[Hydatid disease of the ribs]. / Hydatidose costale.

OBJECTIVES: Hydatid disease is a zoonosis resulting from the growth in man of the larval form of Echinococcus granulosus. Involvement of the bones is rare and localisation to the ribs is exceptional. The aim of our study is to present the pathophysiological and diagnostic characteristics of hydatid disease of the ribs and to define the radiological features. PATIENTS AND METHODS: We undertook a retrospective study, over a period of 10 years, of 12 cases of hydatid rib disease. We have analysed the demographic, clinical and biological parameters and we examined the radiological details as well as the effect of surgery on the progress of the disease. RESULTS: The mean age of the patients was 33.5±10 years. There was no sexual predominance. The clinical picture was characterised by chest pain in ten cases and by swelling in five. General health was satisfactory in all patients. The chest X-rays showed a shadow of water density with lytic rib lesions. Thoracic CT scans showed the relationships with the neighbouring structures, particularly the spinal column. In three cases T1- and T2-weighted MRI scans showed the extent of intraspinal extension and in two cases excluded medullary involvement. Hydatid serology was positive in five cases. All our patients were operated on, with rib resection and vertebral curettage in three cases, and resection of the transverse process in two. Histological examination of the surgical specimens confirmed the diagnosis. Eight patients were treated with albendazole. All patients were reviewed for a mean of 3 years and the progress was favourable. CONCLUSION: Hydatid disease of the ribs is a very rare disorder and the diagnosis is difficult. It is sometimes an unexpected surgical finding but careful examination of the chest X-ray, supplemented by a CT scan, thanks to the liquid density of the lesions, is a great help in diagnosis. However, in the light of the results of our series, the radiological picture may be atypical and the interpretaion difficult.

[Boerhaave's syndrome and pleural tuberculosis]. / Syndrome de Boerhaave et tuberculose pleurale.

INTRODUCTION: Boerhaave's syndrome is a rare condition involving spontaneous rupture of the oesophagus. The diagnosis is difficult and the prognosis depends on early diagnosis and treatment. CASE REPORT: We report a case of spontaneous rupture of the oesophagus in a 70-year-old woman where the diagnosis was delayed. Initial treatment comprised dual antibiotic therapy and feeding via a jejunostomy. Three months later, direct suture of the oesophagus was performed successfully. A routine pleural biopsy performed during the surgery revealed pleural tuberculosis. Antituberculous treatment was given for 6 months with good progress after 16 months follow up. CONCLUSION: Boerhaave's syndrome is a rare condition, the diagnosis of which remains difficult. The prognosis is related essentially to the speed of diagnosis. The treatment is always surgical within the framework of appropriate medical management (intensive care, antibiotic therapy). There should be a systematic search for associated pathology.

[Filling of the thymic space after chemotherapy for ovarian cancer]. / Comblement de la loge thymique après chimiothérapie pour cancer de l'ovaire.

INTRODUCTION: Enlargement of the thymus following remission of a cancer treated by chemotherapy poses a problem of differential diagnosis between benign thymic hyperplasia and relapse of a mediastinal tumour. CASE REPORT: We report the case of a thymic tumour developing 6 months after chemotherapy for ovarian cancer in a woman of 31 years. Because of the risk of a mediastinal recurrence, the patient was submitted to thymectomy by mediastinotomy. Histopathological examination revealed benign thymic hyperplasia in reaction to the chemotherapy. The postoperative course was uneventful. CONCLUSION: Benign thymic hyperplasia may develop after chemotherapy. It is an inflammatory reaction that subsides after a few months. A multidisciplinary discussion to consider the possibility of benign hyperplasia may save the patient unnecessary surgery.

[Outcomes after thoracotomy for intra-abdominal hydatid cysts ruptured into the thorax (a 160 case series)]. / La place de la thoracotomie dans le traitement des kystes hydatiques abdominaux rompus dans le thorax.

INTRODUCTION: The purpose of this study was to assess the results of the surgical treatment of abdominal hydatid cysts ruptured in the thorax. PATIENTS AND METHODS: We collected data from 160 patients who experienced the intra-thoracic rupture of an abdominal hydatid cyst during the period 1997 - 2008: 158 located in the liver, one in the spleen and one in the kidney, which had been treated surgically in a single centre. Diagnosis was based on a history of surgery for abdominal hydatid cysts, specific symptoms including biliptysis (40% of the cases) and expectoration of hydatid cysts, as well as radiological findings (chest x-ray; abdominal ultrasound and CT-scan). All patients were operated on through a thoracotomy. RESULTS: In-hospital mortality was 7.5%. Postoperative complications occurred in 16% and mainly consisted of pleural and pulmonary disorders. CONCLUSION: Thoracotomy offers simultaneous and adequate access to address thoracic and abdominal injuries with a reasonable mortality and morbidity in patients with this condition.

[Bilateral hydatid bilio-bronchial fistula]. / Fistule biliobronchique bilatérale d'origine hydatique.

INTRODUCTION: Bilio-bronchial fistula of hydatid origin is a rare but serious complication of hepatic hydatid cyst, the treatment of which is now well established. CASE REPORT: We report a case of bilateral bilio-bronchial fistula, successfully managed by bilateral thoracotomy with an interval of one week, and complicated by dyspnoea that resolved quickly. CONCLUSION: If the indication for thoracotomy is indisputable in case of unilateral bilio bronchial fistula, an initial laparotomy should be considered in the case of bilateral bilio-bronchial fistula.

[Pneumonectomy for active and sequelae forms of tuberculosis]. / La pneumonectomie pour les formes actives et séquellaires de la tuberculose.

OBJECTIVE: Lung resection retains an important place in the treatment of certain forms of tuberculosis. The purpose of this review was to review the indications for and outcomes of pneumonectomy both in the management of active TB and the treatment of its consequences. MATERIALS AND METHODS: Between 2003 and 2007 85 patients underwent a pneumonectomy for TB; 48 men and 37 women with a mean (sd) age of 36.7 (10.9) years. Chronic sputum production and haemoptysis were the main presenting features. RESULTS: The indication for surgery was a single destroyed lung in 34 cases, an aspergilloma in 29 cases, tuberculous empyema in 14 and multidrug resistant TB in 5. The procedure undertaken was a pneumonectomy in 32 cases a pleurectomy and pneumonectomy in 45 cases and a completion pneumonectomy in 8 cases. There were 4 deaths (4.7%) and in 13 cases (15.3%) a pyothorax developed in the pneumonectomy cavity. In 4 cases a broncho-pleural fistula occurred. Long term results were satisfactory with a median follow up of 2.8years (range 3 months to 5 years). Male sex (p=0.02), right sided pneumonectomy (p=0.01) diabetes (p=0.001), a low level of haemoglobin (p=0.03) or serum protein (p<0.001) were associated with an increased risk of pneumonectomy cavity infection. Right sided surgery (p=0.01), post operative transfusion (p=0.01) and pre-operative empyema (p=0.05) were all associated with risk of bronchial dehiscence. CONCLUSION: Optimising preoperative condition and identification of patients at risk of complications are essential for reducing the burden of post-operative complications.

Primary pulmonary liposarcoma--a case report.

Liposarcoma of the lung is an extremely rare disease with less than 10 cases reported to date. A case of a locally advanced, pulmonary mixed liposarcoma in a 49-year-old male is presented here. Left pneumonectomy with radical lymph node dissection was performed. The postoperative course was uneventful and no recurrence or metastasis was observed for 3 years. Although liposarcoma of the lung is classified as an aggressive, highly metastatic disease, complete resection may result in disease-free survival.

[Multiple extrapulmonary thoracic hydatidosis]. / L'hydatidose thoracique extrapulmonaire multiple.

INTRODUCTION: Extrapulmonary intrathoracic hydatid cysts are unusual but they may be multiple, particularly during a secondary dissemination. With the aim to clarify the origins of this dissemination, we report our experience in the treatment of multiple thoracic extrapulmonary hydatidosis (MTEH). MATERIAL AND METHODS: Between January 1995 and December 2004, 41 patients were operated on for MTEH in our department. Chest roentgenogram and computed tomography were the main means of diagnosis. The treatment consisted of total surgical removal of the intact cysts. The approach was a postero-lateral thoracotomy (right in 29 cases, left in 8 cases, bilateral in 3 cases) and a median sternotomy in one case. All patients received complementary medical treatment with Albendazol. RESULTS: The MTEH was secondary to haematogenous dissemination in 6 patients (15%), to a hydatid cyst of the lung in 7 patients (17%) and to a hydatid cyst of the liver in 28 patients (68%). 75% of these patients had had a previous surgical intervention for hepatic cyst and 88% of them had diaphragm involvement. There were no deaths among our patients but the recurrence rate was 12%. CONCLUSION: Secondary intrathoracic extrapulmonary hydatidosis is generally seen among patients operated on for hydatid cyst of the liver. Necessary precautions must be taken at the time of surgery to avoid any intrathoracic dissemination.

[Thoracic actinomycosis: three cases]. / L'actinomycose thoracique. A propos de trois cas.

Actinomycosis is a rare condition which, in the thoracic localisation, can mimic cancer or tuberculosis. We report a series of three case of thoracic actinomycosis treated in the Ibn Sina University Thoracic Surgery Unit in Rabat, Morocco. CASE N degrees 1: This 45-year-old patient presented a tumefaction on the left anterior aspect of the chest. Physical examination identified a parietal mass with fistulisation to the skin. Radiography demonstrated a left pulmonary mass. Transparietal puncture led to the pathological diagnosis of actinomycosis. The patient was given medical treatment and improved clinically and radiographically. CASE N degrees 2: This 68-year-old patient presented repeated episodes of hemoptysis. The chest x-ray revealed atelectasia of the middle lobe and bronchial fibroscopy demonstrated the presence of a bud in the middle lobar bronchus. Biopsies were negative. The patient underwent surgery and the histology examination of the operative specimen revealed pulmonary actinomycosis. The patient recovered well clinically and radiographically with antibiotic therapy. CASE N degrees 3: This 56-year-old patient presented cough and hemoptysis. Physical examination revealed a left condensation and destruction of the left lung was noted on the chest x-ray. Left pleuropulmonectomy was performed. Histological analysis of the surgical specimen identified associated Aspergillus and Actinomyces. The outcome was favorable with medical treatment. The purpose of this work was to recall the radiological, clinical, histological, therapeutic, outcome aspects of this condition and to relate the problems of differential diagnosis when can suggest other diseases.

[Pulmonary hydatid cyst presenting as dysphonia]. / Kyste hydatique du poumon révélé par une dysphonie.

INTRODUCTION: Dysphonia due to compression of the intrathoracic part of the recurrent laryngeal nerve is usually the result of invasion by a malignant tumour. Compression due to an intrapulmonary hydatid cyst is uncommon. CASE REPORT: We report the case of a 56 year old man who presented with cough, dyspnoea and progressive dysphonia. The chest x-ray and thoracic CT scan showed a cystic mass in the left upper lobe in close contact with the arch of the aorta. At surgery the mass proved to be a hydatid cyst of the lung. The treatment was by cystectomy and histological examination confirmed a hydatid cyst. The post-operative result was satisfactory with relief of the compression and improvement in phonation. CONCLUSION: This report illustrates that hydatid cyst of the lung may occasionally present with signs of mediastinal compression.